Provider Demographics
NPI:1497073217
Name:ENCHANTED HEALING OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:ENCHANTED HEALING OF NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELASARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIHON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-362-5847
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:JEMEZ SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:87025-0023
Mailing Address - Country:US
Mailing Address - Phone:505-362-5847
Mailing Address - Fax:
Practice Address - Street 1:21 KUHN DR
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-8101
Practice Address - Country:US
Practice Address - Phone:505-362-5847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06142101YA0400X, 101YP1600X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty